Individual
MONIQUE LOLITA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
4040 MEMORIAL PKWY SW BLDG 1, HUNTSVILLE, AL 35802-4326
(256) 533-1970
(256) 341-0747
Mailing address
4040 MEMORIAL PKWY SW BLDG 1, HUNTSVILLE, AL 35802-4326
(256) 533-1970
(256) 341-0747
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2586G
AL
1041C0700X
Clinical Social Worker
Primary
4292C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330000014
—
AL
Enumeration date
06/01/2015
Last updated
06/13/2019
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